Sechenov Medical Journal

Advanced search

Effects of COVID-19 on maternal anxiety and depressive disease: a literature review

Full Text:


Scroll to:


The coronavirus SARS-CoV-2 (COVID-19) infection is a public health emergency of international concern. Pandemics pose a challenge to psychological resilience and can have an adverse impact on mental health. The impact of the ensuing social isolation and loneliness imposed by quarantine along with the worries about the risks of the infection and its economic fallout would appear likely to affect the mental health of the population. It has been reported that women are more likely to experience anxiety and depression symptoms during COVID-19 than men. COVID-19 pandemic had a profound impact on the level of anxiety and depression of pregnant women according to their basal level and pregnancy characteristics. Antenatal mental disorders may be a risk factor for maternal mental health problems such as an increased likelihood of postnatal depression and adverse obstetric and developmental outcomes. Effective coping strategies are associated with better psychological wellbeing during the COVID-19 pandemic, including reduced anxiety and depression. The increased risk of mental disorders due to COVID-19 requires policies to be developed to address prenatal and postpartum care to promote maternal-child wellbeing outcomes.

List of abbreviation

  • CI – confidence interval
  • COVID-19 – COrona VIrus Disease 2019
  • IQR – interquartile range
  • SARS – severe acute respiratory syndrome
  • SARS-CoV-2 – severe acute respiratory syndrome coronavirus 2
  • STAI – state-trait anxiety inventory



The COVID-19 outbreak has a major psychological impact on pregnant women

Вспышка COVID-19 оказывает серьезное психологическое воздействие на беременных женщин

SARS-CoV-2 induces anxiety in 77% of pregnant women

Инфекция SARS-CoV-2 вызывает повышенную тревожность у 77% беременных женщин

Anxiety is more frequent in pregnancies with a higher level of education

Повышенная тревожность чаще возникает у беременных с более высоким уровнем образования

Anxiety is more frequent in women unfavorable to COVID-19 vaccination

Повышенная тревожность чаще встречается у женщин, не желающих вакцинироваться от COVID-19

One in three pregnant women experience depression during
the pandemic

Каждая третья беременная женщина испытывает депрессию во время пандемии

The coronavirus 2019-nCoV (COrona VIrus Disease 2019, COVID-19) infection is a public health emergency of international concern in which a coronavirus has been identified as the cause of an outbreak of respiratory illness. It was first detected in Wuhan, China [1], spreading rapidly to other countries worldwide [2][3]. On the 11th of March 2020, the World Health Organization (WHO) announced the new Coronavirus pandemic outbreak according to the WHO official website of the World Health Organization1.

As the pandemic unfolded, public concern about the risks to life and health, inadequate healthcare services, and economic consequences grew. As part of the infection containment strategies, governments around the world imposed unprecedented restrictions on movement, work, and travel for all people in a city, region, or country and these resulted in compromising personal and social liberty. Lockdown and mandatory quarantine are the most commonly used and effective measures that are implemented by governments to contain the transmission of respiratory infectious diseases, including the COVID-19 disease. Within a month of the declaration of the pandemic, 90% of the world’s population was subject to some kind of restriction of movement to limit infection spread2.

In non-pandemic times, quarantine and social isolation are well-known risk factors for psychological and psychiatric disturbances in the general population [4][5], particularly for children and adolescents, the elderly, and those from lower socio-economic groups, females, as well as people with pre-existing mental health conditions [6].

The impact of the ensuing social isolation and loneliness along with the worries about the risks of the infection and its economic fallout would appear likely to have influenced the mental health of the population. Indeed, increased mental health morbidity including anxiety and depression, in a similar context, has been reported previously with fears arising from the severe acute respiratory syndrome (SARS) outbreak [7].

Pandemics pose a challenge to psychological resilience and can have an adverse impact on mental health [8][9], and it has been reported that women are more likely to experience anxiety and depressive symptoms during COVID-19 than men [10].

Prenatal and postnatal mental disorders induce disturbances in the physical activity, nutrition, and sleep of pregnant and postpartum women; these disturbances subsequently affect the mood of pregnant and postpartum women and the development of fetuses and children [11].

Anxiety is a common response to any stressful situation. Pregnant women, who experience mental and physical changes during gestation, are more likely to be at risk. Prevalence of anxiety disorder during pregnancy, in developed and developing countries, are 10 and 25%, respectively [12]. Anxiety symptoms during pregnancy have emerged as an independent risk factor for adverse obstetric and developmental outcomes [13]. Antenatal mental disorders may be a risk factor for maternal mental health problems such as an increased likelihood of postnatal depression [14], impaired bonding [15], and physical disorders, such as preeclampsia [16], gestational hypertension [17], and gestational diabetes [18], preterm birth [19][13] miscarriage [20][21], low infant birth weight and fetal growth restriction [22][23], and lower Apgar scores at birth [24].


A systematic review and meta-analysis that involved 102 studies with 221,974 antenatal and postnatal women from 34 countries found that the pooled prevalence of anxiety among these participants was 15.2% [25].

We hypothesized that the COVID-19 pandemic may have had a profound impact on the level of anxiety of pregnant women that may be different according to their basal level of anxiety and pregnancy characteristics. We therefore performed a study in the days of maximum spread of COVID 19 in Italy (March 9 – March 10, 2020) close to the day of the total lockdown sanctioned by the Italian government (March 9, 2020) [26].

We sent each woman a questionnaire structured into two sections: section A concentrated on 18 items of maternal characteristics and on testing women’s knowledge and concerns about perinatal complications; section B containing 40 items validated the scale for scoring anxiety: state-trait anxiety inventory (STAI).

The STAI is a 40-items scale, which uses a 4-point Likert scale for each item. The scale can be used to measure both trait anxiety (how dispositionally anxious a person is across time and situations) and state anxiety (how anxious a person is feeling at a particular moment) as it consists of two separate sub-scales (STAI-T and STAI-S, respectively) each containing 20 items. An abnormal value of STAI was considered when ≥ 40 [27].

The questionnaire was returned filled by 178 women (89%) within 48 h from the shipment and these women were considered for the study.

A fear that COVID-19 could induce fetal structural anomalies was present in 83 women (46.6%; 95% confidence interval [CI] 39.4–53.9), fetal growth restriction in 116 (65.2%; 95% CI 57.9–71.7) and preterm birth in 91 (51.1%; 95th CI 43.8–58.3). The median trait anxiety score (STAI-T) was 37 (interquartile range [IQR] 20–43) and 68 women (38.2%; 95% CI 31.3–45.5) showed a STAI-T score ≥ 40. The psychological impact of COVID-19 outbreaks, measured using the S scale, revealed increased values of STAI-S scale (median 49 IQR 40–56) with a significant increase of 12 points in median values when compared to T scale (≤ 0.0001). Therefore, there is significantly higher prevalence (77.0%; 95% CI 70.1–82.5) of women that surpass the cut-off score of 40 for state of anxiety when STAI-S was applied (p ≤ 0.0001).

A higher educational status was associated with a significant increase in the prevalence of STAI-S values ≥ 40 (p = 0.004) but not of STAI-T values (p = 0.158). No significant differences in maternal age, gestational age, parity and employment status were evidenced between women with normal (< 40) or abnormal (≥ 40) STAI-T and S scores.

We also performed a study to estimate the propensity of Italian pregnant women receiving the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine during their gestation evaluating the maternal anxiety induced by the vaccination campaign [28][29]. A questionnaire was sent on the 27th of December, the first day of the initiation of SARS-CoV-2 vaccinations in Italy, to 200 women, which was returned filled by 161 women (80.5%). The questionnaire was structured in two sections: part-A aimed to acquire 16 items on maternal characteristics and to test women’s knowledge and concerns about vaccines; part-B containing the STAI.

To evaluate the maternal concern about perinatal complications induced by SARS-CoV-2 vaccination, the following fears were also considered: fetal structural anomalies, growth anomalies, and preterm birth. A fear that the SARS-CoV-2 vaccination could induce fetal structural anomalies was present in 78 women (48.4%; 95% CI 40.5–56.4), fetal growth restriction in 54 (33.5%; 95% CI 26.3–41.4), and preterm birth in 51 (31.6%; 95% CI 24.5–39.4). The median trait anxiety score (STAI-T) was 36 (IQR 31–45), and 61 women (37.9%; 95% CI 30.3–45.8) showed an STAI-T score ≥ 40. The psychological impact of the SARS-CoV-2 vaccine revealed a significant increase in STAI-S values (median 47 IQR 36–56; p < 0.0001) with a positive linear correlation between STAI-T and S scores (Pearson r = 0.48; p < 0.0001).

Of the women considered, 136 (84.5%) felt vaccination was a breakthrough for resolving the pandemic (vaccine positive), while the remaining 25 (25.5%) considered the vaccine not useful (vaccine negative). Among the former group, 72 women (52.9%) were favorable to receiving the vaccine during pregnancy, a percentage significantly higher (p = 0.022) when compared to the vaccine negative group (28%). Further women negative to the SARS-CoV-2 vaccine showed a lower educational level (p < 0.0001) and a higher prevalence of unemployment (p = 0.016) when compared to the vaccine positive group. No differences were found among the other parameters tested. No differences were found between groups in basal anxiety as expressed by the presence of STAI-T values ≥ 40 (positive 37.5%; 95 CI 29.3–46.2 vs. negative 40%; 95 CI 21.1–61.3: p = 0.813), while there was a significant higher prevalence of abnormal STAI-S vales (negative 88.0%; 95% CI 68.7–97.4 vs. positive 63.4%; 95% CI 55.3–72.0) in the group of women negative to a vaccine (p = 0.018).

Our data also showed a high level of trait anxiety with abnormal values in 40% of the pregnant women. We evidenced a subgroup of pregnant women who were negative to vaccination that differs from the positive group for the educational and employment status. Of interest was the fact that, in this group despite the trait anxiety being like the group positive to the vaccine, the anxiety induced by the potential use of the vaccine resulted significantly higher.

According to a systematic review and meta-analysis of 23 studies, with 20,569 participants (16,797 pregnant women and 3,772 postpartum women), during the COVID-19 pandemic and with 3,677 pregnant women before the COVID-19 pandemic, the prevalence rates of anxiety, among pregnant women during the COVID-19 pandemic was 37% (95% CI 25–49%), with a pooled relative risk of anxiety 1.65 (95% CI: 1.25–2.19) relative to those in pregnant women in the same locations during and before the COVID-19 pandemic. Through subgroup analysis, multigravida women had higher prevalence rates of anxiety than primigravida women, and the prevalence of anxiety decreased during pregnancy [30].

Moreover, H. Yan et al. [30] found several results that contradicted the results of some previous studies and highlighted a higher prevalence of anxiety among pregnant women with a university degree or above than amongst pregnant women with low educational levels [31] and a higher prevalence of anxiety among employed pregnant women than among unemployed pregnant women [32]. High educational level indicates high knowledgeability, which may amplify the adverse effects of mental health during the COVID-19 pandemic, and employed pregnant women may face difficult situations such the loss of jobs and earnings due to the COVID-19 pandemic. These difficult situations have a negative influence on mental health.


A systematic review and meta-analysis including 101 studies discovered that the pooled prevalence of depression among women in the perinatal period was 11.9% [33]. The prevalence of postpartum depression was evaluated at 12.0% in a systematic review and meta-analysis that encompassed 58 studies with 37,294 postnatal women [34].

Y. Wu et al. showed that the prevalence of depressive symptoms amongst pregnant women increased from 26% to 34.2% at the beginning of the pandemic, with the contemporary increase in anxiety symptoms [35].

In a meta-analysis of eight studies on 7,750 women, despite depression through the Edinburgh Postnatal Depression Scale score increasing among women in pregnancy and the perinatal period during the COVID-19 pandemic, it did not reach a statistically significant level compared to the non-pandemic period [36].

A systematic review and meta-analysis conducted with 20,569 participants showed that the prevalence rates of depression among pregnant women during the COVID-19 pandemic was 31% (95% CI 20–42%). The prevalence of postpartum depression during the COVID-19 pandemic was 22% (95% CI 15–29%). The pooled relative risk of depression in pregnant women was 1.08 (95% CI: 0.80–1.46), relative to those in pregnant women in the same locations during and before the COVID-19 pandemic [30].

Multigravida women had higher prevalence rates of depression than primigravida women during the COVID-19 pandemic, and the prevalence of depression followed a U pattern. Specifically, the prevalence of depression was high in the first and third trimesters and was the lowest in the second trimester.

There is evidence for higher depression scores among pregnant women with longer years of education [37].

U. Akgor et al. [38] observed higher levels of depression in older pregnant women, and especially aged 35 and over. This data is consistent with other studies [39][40]. However, some studies reported the opposite and concluded that younger pregnant women were more prone to depression during the COVID pandemic [35][41].

In a survey of 257 participants, the youngest age group (18–25 years) accounts for the largest proportion (10/22, 45.5 %) of people with both depression and anxiety, and this was consistent among depressed people (17/50, 34.0%) [42].

Low socioeconomic status was confirmed as one of several risk factors for depressive symptoms [35].

Pregnant women who worry about their finances were more likely to have higher clinical depression scores (adjusted Odds Ratio: 2.23; 95 % CI = 1.80, 2.77, p < 0.001, adjusted model R2 = 0.06). Pregnant women with both high and low incomes were at risk of developing depression if they experienced COVID-19-associated financial stress [43].

Women who reported poor social support and social isolation also have higher depressive symptoms at all-time points. Loneliness was also associated with a greater increase in depressive symptoms although not anxiety symptoms, from prior to during the pandemic [44].

According to psychodynamics, depression is a general state of inhibition, where actions are undermined, however, anxiety is a general state of alertness that motivates people toward to actions. The presence of a factor that affects the whole world, such as a pandemic process, where both being in the hospital and not being able to come to the hospital cause concerns, can explain the positive correlation between these two different and almost opposite feelings.


Coping is a primary component of an individual’s response to stressful events [45]. Several studies have shown that effective coping strategies are associated with better psychological wellbeing during the COVID-19 pandemic, including reduced anxiety and depression [46–50].

The assessment of coping is crucial to understanding the ways in which psychological stress and stressful life events can be buffered partly from being able to control the stressor or relying on support from others (i.e., social support) [45][51][52][53]. Sociocultural contexts must be considered in the study of perinatal stress and coping [54]. Coping strategy can also vary depending on race, ethnicity, and socioeconomic status [55][56].

Research has distinguished between three major types of coping: (1) problem-focused coping, which involves actions aimed at addressing the problem (e.g., planning, seeking instrumental support), (2) emotion-focused coping, which aims to manage negative emotions (e.g., seeking emotional support, cognitive restructuring), and (3) dysfunctional coping, which involves maladaptive strategies that are not helpful in dealing with the stressor (e.g., denial, behavioral disengagement) [57].

J.E. Khoury et al. [58] found that particular COVID-19-related experiences were differentially associated with distinct forms of coping. Specifically, individuals who saw the COVID-19 pandemic as having a greater negative impact engaged in more dysfunctional coping and less emotion-focused coping. In contrast, greater financial difficulties and social isolation were associated with more dysfunctional coping and problem-focused coping, but not emotion-focused coping [58].


Increased risk of mental disorders due to COVID-19 requires that policies are developed to address prenatal and postpartum care to promote maternal–child wellbeing outcomes. It is important for health professional working with childbearing women to identify any stressors during prenatal care and provide resources to obtain psychological support to manage and/or reduce their impact [59].

Health professional should increase awareness about the transmission of the disease, explaining the precautions that can be taken for prenatal, postpartum, breastfeeding, and neonatal care; and asking patients for psychiatry consultation to increase the psychiatric well-being of pregnant women [38].

H. Bayrampour et al. [60] showed that the higher the risk perception level of pregnant women, the more severe the anxiety level. Therefore, medical teams should make the risk perception level of pregnant women precise by spreading accurate information to them to reduce their anxiety levels. Social support could regulate anxiety directly and negatively or affect it indirectly through risk perception. Thus, during the epidemic, health professionals can take two measures to maintain the mental health of pregnant woman and reduce anxiety: actively mobilize the social support system for pregnant women and reduce the risk perception level of pregnant women in relation COVID-19 [61].

Social support includes subjective and objective support, and its utilization. Previous studies have shown that a high level of social support plays a protective role against anxiety during pregnancy [62][63]. Social support can play a direct protective role in individuals’ negative emotions, by helping with behavior and providing emotional support. In addition, social support can also improve the assessment and coping skills of individuals, reduce the perceived severity of stressful events, and thus play an indirect protective role in mental health [64].

Recent meta-analyses of randomized controlled trials have shown that pre- and post-natal exercise can reduce depression and depressive symptoms [65].

During the COVID-19 pandemic pregnant women have shown a significant decrease in engagement in physical activity compared to their lifestyle habits during pregnancy from before the confinement. Physical exercise has been demonstrated to be effective in the treatment of mild to moderate depression in the non-pregnant population [66]. Physical activity is a relatively costless intervention that can improve maternal wellbeing [67][68].

Moreover, a self-care daily program can be based on the NEST-S principles: Nutrition, Exercise, Sleep, Time for Self, Support can be helpful3.

HealthCare providers must have clear evidence-informed guidelines in place for either treating individuals or referring to other professionals, and, in the event of referral, ensuring that patients are assisted [69].


There is a greater psychological impact, as well as higher rates of anxiety and depression, in pregnant women during the COVID-19 outbreak, and this highlights the need for intervention. Meeting the mental health needs of pregnant and postpartum women during the COVID-19 pandemic is a growing concern and a serious issue because a large body of robust evidence suggests that prenatal and postnatal mental disorders induce severe adverse influences on mothers, fetuses, and children.

The identification of high-risk women is crucial in order to be able to suggest the possible implementation of early psychological interventions and prevent some pregnancy stress-related complications.

1. Accessed July 27th, 2021.

2. Accessed July 27th, 2021.

3. Accessed July 27th, 2021.


1. Li Q., Guan X., Wu P., et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020 Mar 26; 382(13): 1199-1207. PMID: 31995857.

2. The Lancet. COVID-19: too little, too late? Lancet. 2020 Mar 7; 395(10226): 755. PMID: 32145772.

3. Day M. Covid-19: surge in cases in Italy and South Korea makes pandemic look more likely. BMJ. 2020 Feb 25; 368: m751. PMID: 32098875.

4. Brooks S.K., Webster R.K., Smith L.E., et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020 Mar 14; 395(10227): 912-920. PMID: 32112714.

5. Usher K., Bhullar N., Jackson D. Life in the pandemic: social isolation and mental health. J Clin Nurs. 2020 Aug; 29(15-16): 2756-2757. PMID: 32250493.

6. Perrin P.C., McCabe O.L., Everly G.S., Links J.M. Preparing for an influenza pandemic: mental health considerations. Prehosp Disaster Med. 2009 May-Jun; 24(3): 223-230. PMID: 19618359.

7. Maunder R., Hunter J., Vincent L., et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003 May 13; 168(10): 1245-1251. PMID: 12743065.

8. Pfefferbaum B., North C.S. Mental health and the Covid-19 pandemic. N Engl J Med. 2020 Aug 6; 383(6): 510-512. PMID: 32283003.

9. Crouse Quinn S. Crisis and emergency risk communication in a pandemic: a model for building capacity and resilience of minority communities. Health Promot Pract. 2008 Oct; 9(4 Suppl): 18S-25S. PMID: 18936256.

10. Wang C., Pan R., Wan X., et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020 Mar 6; 17(5): 1729. PMID: 32155789.

11. Coussons-Read M.E. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstet Med. 2013 Jun; 6(2): 52-57. PMID: 27757157.

12. Martini J., Petzoldt J., Einsle F., et al. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective - longitudinal study. J Affect Disord. 2015 Apr 1; 175: 385-395. PMID: 25678171.

13. Ding X.X., Wu Y.L., Xu S.J., et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord. 2014 Apr; 159: 103-110. PMID: 24679397.

14. Coelho H.F., Murray L., Royal-Lawson M., Cooper P.J. Antenatal anxiety disorder as a predictor of postnatal depression: a longitudinal study. J Affect Disord. 2011 Mar; 129(1-3): 348353. PMID: 20805004.

15. Lindgren K. Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health. 2001 Jun; 24(3): 203-217. PMID: 11526619.

16. Zhang S., Ding Z., Liu H., et al. Association between mental stress and gestational hypertension/preeclampsia: a meta-analysis. Obstet Gynecol Surv. 2013 Dec; 68(12): 825-834. PMID: 25102019.

17. Asghari E., Faramarzi M., Mohammmadi A.K. The effect of cognitive behavioural therapy on anxiety, depression and stress in women with preeclampsia. J Clin Diagn Res. 2016 Nov; 10(11): Qc04-qc07. PMID: 28050449.

18. Gilbert L., Gross J., Lanzi S., et al. How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review. BMC Pregnan Childbirth. 2019 Feb 7; 19(1): 60. PMID: 30732571.

19. Grigoriadis S., Graves L., Peer M., et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J Clin Psychiatry. 2018 Sep 4; 79(5): 17r12011. PMID: 30192449.

20. Accortt E.E., Cheadle A.C., Dunkel Schetter C. Prenatal depression and adverse birth outcomes: an updated systematic review. Mater Child Health J. 2015 Jun; 19(6): 1306-1337. PMID: 25452215.

21. Qu F., Wu Y., Zhu Y.H., et al. The association between psychological stress and miscarriage: a systematic review and meta-analysis. Sci Rep. 2017 May 11; 7(1): 1731. PMID: 28496110.

22. Grote N.K., Bridge J.A., Gavin A.R., et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010 Oct; 67(10): 1012-1024. PMID: 20921117.

23. Ciesielski T.H., Marsit C.J., Williams S.M. Maternal psychiatric disease and epigenetic evidence suggest a common biology for poor fetal growth. BMC Pregnancy Childbirth. 2015 Aug 25; 15: 192. PMID: 26303856.

24. Wu Y., Lu Y.C., Jacobs M., et al. Association of prenatal maternal psychological distress with fetal brain growth, metabolism, and cortical maturation. JAMA Netw Open. 2020 Jan 3; 3(1): e1919940. PMID: 31995213.

25. Dennis C.L., Falah-Hassani K., Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017 May; 210(5): 315-323. Epub 2017 Mar 16. PMID: 28302701.

26. Mappa I., Distefano F.A., Rizzo G. Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: a prospectic observational study. J Perinat Med. 2020 Jul 28; 48(6): 545-550. PMID: 32598320.

27. Spielberger C.D., Gorsuch R.I., Lushene R.E. STAI manual for the state-trait anxiety inventory. In Spielberger CD, Editor, State - Trait anxiety inventory for adults. Sampler set, manual set, scoring key. Palo Alto CA: Consulting Psychologists Press. 1983.

28. Mappa I., Luviso M., Distefano F.A., et al. Women perception of SARS-CoV-2 vaccination during pregnancy and subsequent maternal anxiety: a prospective observational study. J Matern Fetal Neonatal Med. 2021 Apr 11: 1-4. Epub ahead of print. PMID: 33843419.

29. Carbone L., Mappa I., Sirico A., et al. Pregnant women's perspectives on severe acute respiratory syndrome coronavirus 2 vaccine. Am J Obstet Gynecol MFM. 2021 Jul; 3(4): 100352. Epub 2021 Mar 23. PMID: 33771762.

30. Yan H., Ding Y., Guo W. Mental health of pregnant and postpartum women during the coronavirus disease 2019 pandemic: A systematic review and meta-analysis. Front Psychol. 2020 Nov 25; 11: 617001. PMID: 33324308.

31. Kannenberg K., Weichert J., Rody A., Banz-Jansen C. Treatment-associated anxiety among pregnant women and their partners: What is the influence of sex, parity, age and education? Geburtshilfe Frauenheilkd. 2016 Jul; 76(7): 809-813. PMID: 27582579.

32. Rubertsson C., Hellstrom J., CrossM., Sydsjo G. Anxiety in early pregnancy: prevalence and contributing factors. Arch Womens Ment Health. 2014 Jun; 17(3): 221-228. Epub 2014 Jan 18. PMID: 24442712.

33. Woody C.A., Ferrari A.J., Siskind D.J., et al. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017 Sep; 219: 86-92. Epub 2017 May 8. PMID: 28531848.

34. Shorey S., Chee C.Y.I., Ng E.D., et al. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. J Psychiatr Res. 2018 Sep; 104: 235248. Epub 2018 Aug 3. PMID: 30114665.

35. Wu Y., Zhang C., Liu H., et al. Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. Am J Obstet Gynecol. 2020 Aug; 223(2): 240.e1-240.e9. Epub 2020 May 11. PMID: 32437665.

36. Hessami K., Romanelli C., Chiurazzi M., Cozzolino M. COVID-19 pandemic and maternal mental health: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020 Nov 1: 1-8. Epub ahead of print. PMID: 33135523.

37. Durankuq F, Aksu E. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study. J Matern Fetal Neonatal Med. 2020 May 18: 1-7. Epub ahead of print. PMID: 32419558.

38. Akgor U., Fadiloglu E., Soyak B., et al. Anxiety, depression and concerns of pregnant women during the COVID-19 pandemic. Arch Gynecol Obstet. 2021 Jul; 304(1): 125-130. Epub 2021 Jan 12. PMID: 33433702.

39. Muraca G.M., Joseph K.S. The association between maternal age and depression. J Obstet Gynaecol Can. 2014 Sep; 36(9): 803810. PMID: 25222359.

40. Spence N.J. The long-term consequences of childbearing: Physical and psychological well-being of mothers in later life. Res Aging. 2008; 30(6): 722-751. PMID: 19122886.

41. Giri A., Srivastav V.R., Suwal A., Tuladhar A.S. Advanced maternal age and obstetric outcome. Nepal Med Coll J. 2013 Jun; 15(2): 87-90. PMID: 24696922.

42. Patabendige M., Gamage M.M., Weerasinghe M., Jayawardane A. Psychological impact of the COVID-19 pandemic among pregnant women in Sri Lanka. Int J Gynaecol Obstet. 2020 Oct; 151(1): 150-153. Epub 2020 Aug 17. PMID: 32731307.

43. Thayer Z.M., Gildner T.E. COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States. Am J Hum Biol. 2021 May; 33(3): e23508. Epub 2020 Sep 22. PMID: 32964542.

44. Perzow S.E.D., Hennessey E.P., Hoffman M.C., et al. Mental health of pregnant and postpartum women in response to the COVID-19 pandemic. J Affect Disord Rep. 2021 Apr; 4: 100123. Epub 2021 Feb 25. PMID: 33649750.

45. Folkman S., Lazarus R.S. An analysis of coping in a middle-aged community sample. J Health Soc Behav. 1980 Sep; 21(3): 219239. PMID: 7410799.

46. Brehl A.-K., Schene A., Kohn N., Fernandez G. Maladaptive emotion regulation strategies in a vulnerable population predict increased anxiety during the Covid-19 pandemic: A pseudo-prospective study. J Afect Disord. 2021; 4: 100113.

47. Groarke J.M., Berry E., Graham-Wisener L., et al. Loneliness in the UK during the COVID-19 pandemic: cross-sectional results from the COVID-19 psychological wellbeing study. PLoS One. 2020; 15(9): e0239698. PMID: 32970764.

48. Jiang H.J., Nan J., Lv Z.Y., Yang J. Psychological impacts of the COVID-19 epidemic on chinese people: exposure, post-traumatic stress symptom, and emotion regulation. Asian Pac J Trop Med. 2020; 13(6):252-259.

49. Jungmann S.M., Witthoft M. Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: which factors are related to coronavirus anxiety? J Anxiety Disord. 2020; 73: 102239. PMID: 32502806.

50. Fullana M.A., Hidalgo-Mazzei D., Vieta E., Radua J. Coping behaviors associated with decreased anxiety and depressive symptoms during the COVID-19 pandemic and lockdown. J Affect Disord. 2020; 275: 80-81. PMID: 32658829.

51. Folkman S. Personal control and stress and coping processes: a theoretical analysis. J Pers Soc Psychol. 1984; 46(4): 839-852. PMID: 6737195.

52. Cohen S., Hoberman H.M. Positive events and social supports as buffers of life change stress. J Appl Soc Psychol. 1983; 13(2): 99-125.

53. Cohen S., Wills T.A. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985; 98(2): 310-357. PMID: 3901065.

54. Rini C.K., Dunkel-Schetter C., Wadhwa P.D., Sandman C.A. Psychological adaptation and birth outcomes: the role of personal resources, stress, and sociocultural context in pregnancy. Health Psychol. 1999; 18(4): 333-345. PMID: 10431934.

55. Grobman W.A., Parker C.B., Willinger M., et al. Racial disparities in adverse pregnancy outcomes and psychosocial stress. Obstet Gynecol. 2018; 131(2): 328-335. PMID: 29324613.

56. Tegethoff M., Greene N., Olsen J., et al. Stress during pregnancy and offspring pediatric disease: a national cohort study. Environ Health Perspect. 2011; 119(11): 1647-1652. PMID: 21775267.

57. Folkman S., Moskowitz J.T. Coping: pitfalls and promise. Annu Rev Psychol. 2004; 55: 745-774. PMID: 14744233.

58. Khoury J.E., Atkinson L., Bennett T., et al. Coping strategies mediate the associations between COVID-19 experiences and mental health outcomes in pregnancy. Arch Womens Ment Health. 2021; 1-11. PMID: 34145499.

59. Goyal D., Selix N.W. Impact of COVID-19 on maternal mental health. MCN Am J Matern Child Nurs. 2021; 46(2): 103-109. PMID: 33470613.

60. Bayrampour H., Heaman M., Duncan K.A., Tough S. Predictors of perception of pregnancy risk among nulliparous women. J Obstet Gynecol Neonatal Nurs. 2013; 42(4): 416-427. PMID: 23773117.

61. Yue C., Liu C., Wang J., et al. Association between social support and anxiety among pregnant women in the third trimester during the coronavirus disease 2019 (COVID-19) epidemic in Qingdao, China: the mediating effect of risk perception. Int J Soc Psychiatry. 2021; 67(2): 120-127. PMID: 32643510.

62. Gumugsoy S., Keskin G., Qigek O., et al. Psychological problem areas of pregnant women diagnosed with abortus imminens as a result of assisted reproductive techniques: a comparative study. Perspect Psychiatr Care. 2021; 57(1): 73-81. PMID: 32367580.

63. Nath A., Venkatesh S., Balan S., et al. The prevalence and determinants of pregnancy-related anxiety amongst pregnant women at less than 24 weeks of pregnancy in Bangalore, Southern India. Int J Womens Health. 2019; 11: 241-248. PMID: 31114392.

64. Lakey B., Orehek E. Relational regulation theory: a new approach to explain the link between perceived social support and mental health. Psychol Rev. 2011; 118(3): 482-495. PMID: 21534704.

65. Davenport M.H., McCurdy A.P., Mottola M.F., et al. Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms: a systematic review and meta-analysis. Br J Sports Med. 2018; 52(21): 1376-1385. PMID: 30337464.

66. Cooney G.M., Dwan K., Greig C.A., et al. Exercise for depression. Cochrane Database Sys Rev. 2013; 12(9): CD004366. PMID: 24026850.

67. Rabiepoor S., Rezavand S., Yas A., Ghanizadeh N. Influential factors in physical activity amongst pregnant women. Balt J Health Phys Activ. 2019; 11(2): 36-45.

68. Zerf M. Effects of walking training performed using continuous and interval methods on weight loss as effective strategies among postpartum women. Balt J Health Phys Activ. 2019; 11(1): 54-61.

69. Sani G., Janiri D., Di Nicola M., et al. Mental health during and after the COVID-19 emergency in Italy. Psychiatry Clin Neurosci. 2020; 74(6): 372. PMID: 32248608.

About the Authors

I. Mappa
University of Rome Tor Vergata, Fondazione Policlinico Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re

Ilenia Mappa - MD, PhD, University of Rome Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re.

00167, Roma.

Tel.: +39 06 612451

F. A. Distefano
University of Rome Tor Vergata, Fondazione Policlinico Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re

Flavia Adalgisa Distefano - BS, University of Rome Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re.

00167, Rome.

G. Rizzo
University of Rome Tor Vergata, Fondazione Policlinico Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re

Giuseppe Rizzo - MD, Professor and Chairman, University of Rome Tor Vergata, Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata.

00167, Rome.


Views: 572

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2218-7332 (Print)
ISSN 2658-3348 (Online)